Dental mythbuster 40: Caring for people with dementia in a dental practice

Page last updated: 3 July 2023

Symptoms of dementia

Symptoms include problems with:

memory loss
mental sharpness and speed of thinking
language, such as using the wrong words or difficulty speaking
understanding
judgement
mood
movement
carrying out daily activities.

The symptoms of dementia are caused by progressive changes in the brain cells. People with dementia have a physical brain disorder, even though the symptoms they have are predominantly mental. This is because the parts of the brain affected by dementia are responsible for our higher mental functions. Higher mental functions include memory, orientation, language and interpretation (visual particularly).

Somebody with dementia may have recent memory impairment (forgetting appointments or medication, or mislaying items). As the dementia progresses, the memory impairment progresses backwards. The person may start ‘living in the past’ perhaps calling you by the name of a dentist they had many years ago or giving the receptionist an old address.

Research shows there are currently around 900,000 people in the UK with dementia. The number of people with dementia is increasing because people are living longer. It is estimated that by 2040, the number of people with dementia in the UK will reach 1.6 million.

The language of dementia

The Alzheimer’s Society is one of the main dementia charities in the UK. It advises that the language we use regarding people with dementia should not imply something negative. People with dementia should not be regarded as ‘dementia patients’ or ‘dementia sufferers’. This paints a negative image and de-personalises them, focusing on the dementia and not on the whole person. The more neutral phrase, ‘people with dementia’ reminds us that people with dementia are a lot more than the dementia alone. Similarly, we can speak of somebody ‘living with dementia’.

People with dementia are likely to develop language difficulties (dysphasia). Initially they may be unable to find words easily and get frustrated with themselves. As their dementia progresses, they may have difficulty in following complex sentences, so you may need to break up the information you are communicating into smaller segments. Remember that you may not get an accurate reply to questions about when something happened.

Dental treatment for people with dementia must combine:

best current dental practice, guided by what is appropriate according to where the person is on the dementia pathway
the overarching requirements of the Mental Capacity Act 2005.

In the dental practice

It is essential that people with dementia are treated with dignity and respect as laid out in Regulation 10: Dignity and respect

When treating people with dementia, clinicians must obtain informed consent for any treatment provided. This must be in line with:

The Mental Capacity Act 2005 states that you must assume a person has the capacity to make a decision themselves, unless it's proved otherwise. This means that clinicians should not assume that someone cannot make a decision for themselves just because they have a particular medical condition or disability.

This is essential when treating people on the dementia pathway as their mental capacity may fluctuate. This can depend on different factors, such as the severity of the disease process or the time of day. A patient may lack capacity at one point in time but may be able to make the same decision at a later point.

Getting consent for treatment may need to be at a very simple level. Complex explanations will not help and will cause confusion. You may need to use simple ‘one bit’ questions, for example:

“does it hurt?”
“please show me”
“please open your mouth”
“please let me look”
“a filling would make it better”
“shall I do a filling?”

This method of giving one bit of information at a time may enable you to obtain consent under the Mental Capacity Act 2005, when more complex sentences may fail.

People with dementia are more likely to suffer from dental disease such as dental decay and periodontal disease. This can be from a more sugary diet, poor self-care (such as toothbrushing) or poor access to dental services. This can lead to pain and swelling, and in turn to dehydration, malnutrition and may affect the quality of life. It is important to identify people with dementia so you can plan and deliver early oral hygiene preventative intervention. This can help reduce the likelihood of problems later.

Early oral health intervention includes:

providing detailed oral hygiene instructions to the patient and carers
applying fluoride products
planning for any future dental problems.

Dementia UK’s Mouth care for people with dementia provides information about the importance of maintaining good oral health.

When we inspect

We expect providers to consider people with dementia and take reasonable steps to help them receive dental treatment in a kind and compassionate way.

Staff training and awareness

It is important that all staff are aware of dementia to make the visit as smooth as possible for the patient. If possible, allow extra time for the consultation if you know that a person has dementia. Staff can become a Dementia Friend or attend dementia awareness sessions. They can also have formal dementia training that meets the Dementia Training Standards Framework for health and social care professionals.

Reasonable adjustments

This involves developing a dementia friendly environment. For example, ensuring that the environment promotes wellbeing, security and a sense of orientation for people with dementia.

Some people with dementia may seem to have problems with their vision. The problem may not actually be in their eyes but in the part of the brain that interprets what is seen. For example, they may interpret a changing pattern or material on the floor as a step, misjudge it and fall.

It is useful to undertake a dementia friendly review of your practice. You could ask somebody with dementia to come to your practice and advise you on how to improve your facilities, paying particular attention to:

flooring
steps
lighting
signage (the toilet sign should have an illustration of a toilet, rather than a modern male/female icon)
toilets (if possible, contrast the toilet seat with the pedestal).

Most people with dementia who attend a dental practice are likely to have a carer with them. Use the carer’s knowledge of the patient to make the consultation or treatment as comfortable and stress free as possible.

Communication is another key element to helping people with dementia. You may need to adjust communication strategies to meet their needs. This could involve suggesting that patients and carers use the Alzheimer’s Society “This is Me” tool. The tool may help staff know what can help reduce distress. If the patient has difficulty hearing, make sure you reduce any background sounds (such as a radio or decontamination equipment).

Governance arrangements

People with dementia may be at a higher risk of abuse. This may be physical, emotional, sexual, financial, institutional or neglect. All staff have a responsibility to recognise, respond to, report and record any concerns about the welfare of any people who are subject to abuse or neglect. This should be done in line with the practice’s safeguarding policy.

Notable practice

Our inspections of dental practices have highlighted some examples of notable practice for people with dementia .